Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya

Abstract

Introduction Despite the increased risk of cervical cancer among HIV-positive women, many HIV-care programs do not offer integrated cervical cancer screening. Incorporating self-collected Human Papillomavirus (HPV) testing into HIV programs is a potential strategy to identify women at higher risk for cervical cancer while leveraging the staffing, infrastructure and referral systems for existing services. Community-based HIV and HPV testing has been effective and efficient when offered in single-disease settings. Methods This cross-sectional study was conducted within a community outreach and multi-disease screening campaigns organized by the Family AIDS Care and Education Services in Kisumu County, Kenya. In addition to HIV testing, the campaigns provided screening for TB, malaria, hypertension, diabetes, and referrals for voluntary medical male circumcision. After these services, women aged 25–65 were offered self-collected HPV testing. Rates and predictors of cervical cancer screening uptake and of HPV positivity were analyzed using tabular analysis and Fisher’s Exact Test. Logistic regression was performed to explore multivariate associations with screening uptake. Results Among the 2016 women of screening age who attended the outreach campaigns, 749 women (35.6%) were screened, and 134 women (18.7%) were HPV-positive. In bivariate analysis, women who had no children (p < 0.01), who were not pregnant (p < 0.01), who were using contraceptives (p < 0.01), who had sex without using condoms (p < 0.05), and who were encouraged by a family member other than their spouse (p < 0.01), were more likely to undergo screening. On multivariable analysis, characteristics associated with higher screening uptake included: women aged 45–54 (OR 1.62, 95% CI 1.05–2.52) compared to women aged 25–34; no children (OR 1.65, 95% CI 1.06–2.56); and family support other than their spouse (OR 1.53, 95% CI 1.09–2.16). Women who were pregnant were 0.44 times (95% CI 0.25–0.76) less likely to get screened. Bivariate analyses with participant characteristics and HPV positivity found that women who screened HPV-positive were more likely to be HIV-positive (p < 0.001) and single (p < 0.001). Conclusions The low screening uptake may be attributed to implementation challenges including long waiting times for service at the campaign and delays in procuring HPV test kits. However, given the potential benefits of integrating HPV testing into HIV outreach campaigns, these challenges should be examined to develop more effective multi-disease outreach interventions.

Improving cervical cancer screening rates among women of reproductive age in rural Kisumu County through dialogue-based community health education

“…The current study reported low cervical cancer screening rates among the study participants in both arms. Similar low screening rates were reported by a study among women in Kenya where only 35.6% of the eligible women were screened [ 13 ]. Among Ghanaian women, only 24.6% of those eligible were screened despite the close proximity to facilities offering free cervical cancer screening services [ 14 ].…”

Real-World Cervical Cancer Screening Uptake and Predictors of Visual Inspection With Acetic Acid Positivity Among Women Living With HIV in Care Programs in Western Kenya

“…Modeling studies demonstrate that achieving the 90/70/90 targets will avert 74 million new cases of cervical cancer and 62 million deaths in LMICs. 44 Our findings, along with other studies looking at CCS coverage in Kenya, 45 reveal a great need to scale up CCS coverage in HIV programs caring for women at the highest risk of cervical cancer to attain the WHO elimination targets and save millions of lives. As a result of inadequate secondary prevention for WLWHIV, few of whom were vaccinated against HPV, cervical cancer is a leading cause of cancer death among WLWHIV in LMICs.…”

Providers and women’s perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study

“…This is due to uncertainties surrounding self-collected HPV testing, concerns about self-efficacy in self-sampling [ 32 ], and results delivery [ 29 ] reported elsewhere. Additionally, low uptake of self-collected HPV testing was registered in Kenya among 25-34-year-old women at multi-disease community health fairs [ 38 ], highlighting the importance of tailoring HPV-based self-collection strategies to address the specific needs of women at different age groups. Beneficiary-collected samples being less accurate than clinician-collected ones due to potential user error and lack of familiarity with the procedure have been reported [ 39 ].…”